Assessment of nonimmunologic factors in kidney transplant recipients according to Kidney Disease Improving Global Outcomes

INTRODUCTION

Cardiovascular disease is the primary cause of death among kidney transplant recipients (KTRs), whereas chronic allograft nephropathy (CAN) is the main reason leading to end-stage chronic kidney disease. The etiologies of both entities include immunologic and nonimmunologic factors. The management of modifiable nonimmunologic parameters has recently been identified by the Kidney Disease Improving Global Outcomes (KDIGO) guidelines. The aim of our study was to assess the implementation of these guidelines in the outpatient kidney transplantation clinic of our hospital.

PATIENT AND METHODS

We retrospectively monitored the records of 48 transplanted KTRs including 32 males of overall mean age 45.1 ± 10.7 years regarding control of anemia, dyslipidemia, mineral bone disorder (MBD), and blood pressure (BP) levels. Data were recorded every 6 months for 2 years, starting 1 year after renal transplantation.

RESULTS

The estimated glomerular filtration rate of patients at baseline was 60.3 ± 18.8 mL/min/1.73 m(2) with no significant change during 2 years of follow-up. The control of anemia was satisfactory in 42 patients (88%) with hemoglobin values ≥ 11 g/dL during the follow-up. Regarding dyslipidemia management, the aggregate of patients showed fasting triglycerides ≤500 mg/dL in all measurements. The percentage of KTRs with LDL ≤100 mg/dL tended to improve from baseline versus the end of the study period (20.8% vs 41.7%). Serum calcium was satisfactorily controlled in 77% of patients, serum phosphorus in all patients, whereas parathyroid hormone (PTH) was abnormal in 60% of KTRs with chronic kidney disease stages 3-5. Finally, the BP goal of <130/80 mm Hg was achieved in approximately half of the patients.

CONCLUSION

Control of nonimmunologic factors was satisfactory in terms of renal anemia and MBD, whereas dyslipidemia and BP levels were inadequately controlled. There is a clear need for better integration into clinical practice of KDIGO guidelines with regard to modifiable nonimmunologic factors.

LX1032: A potential new therapy for carcinoid syndrome (CS)

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Background: Patients with metastatic CS experience a variety of symptoms due to increased serotonin (5-HT) produced by metastatic GI tumor cells. The enzyme tryptophan hydroxylase (TPH) catalyzes the rate-limiting step in the synthesis of 5-HT. Reducing 5-HT synthesis by TPH inhibition represents a new mechanism for potentially managing symptoms associated with CS. LX1032 is a novel, orally bioavailable TPH inhibitor designed to afford systemic exposure without affecting 5-HT synthesis in the CNS. Preclinical studies of LX1032 in multiple species confirmed systemic inhibition of 5-HT synthesis without changes in brain 5-HT levels. Methods: Single (n=47 subjects) and multiple (n=40 subjects) ascending dose studies with LX1032 were completed in normal volunteers; 24-hr urinary 5-HIAA and blood 5-HT were measured as biomarkers of 5-HT metabolism. Results: LX1032 produced a significant dose-dependent reduction in urinary 5-HIAA and blood 5-HT levels, with maximal reductions observed at doses at or above 500 mg, once daily, in the 14 day multiple ascending dose (MAD) study; the mean change from baseline in blood 5-HT was -30% for the 1500 mg (500 mg TID) dose group. Single doses up to 500 mg were well tolerated with no evidence of dose limiting toxicity or tolerability; GI related adverse events (nausea, emesis, and diarrhea) started to emerge at the 1,000 mg dose level and became dose-limiting at the 1,500 mg single dose level. Multiple doses were well tolerated at all dose levels up to 1.500 mg (500 mg TID). Adverse events (AEs) were mild to moderate and no serious AEs occurred; a dose-dependent, mild increase in hepatic transaminase levels was observed in the MAD study. Conclusions: Inhibiting TPH, and thereby reducing peripheral 5-HT production, represents a potential new approach for managing symptoms in CS patients. LX1032 is a novel, orally bioavailable TPH inhibitor that significantly reduced 5-HT production at well tolerated dose levels. The favorable safety profile and observed decrease in urinary 5-HIAA and blood 5-HT levels indicate that LX1032 could be used to lower 5-HT as a potential new approach for managing hyperserotoninemia-related complications of CS, and support studies of the compound in CS patients.

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The public health impact of avian influenza viruses

Influenza viruses with novel hemagglutinin and 1 or more accompanying genes derived from avian influenza viruses sporadically emerge in humans and have the potential to result in a pandemic if the virus causes disease and spreads efficiently in a population that lacks immunity to the novel hemagglutinin. Since 1997, multiple avian influenza virus subtypes have been transmitted directly from domestic poultry to humans and have caused a spectrum of human disease, from asymptomatic to severe and fatal. To assess the pandemic risk that avian influenza viruses pose, we have used multiple strategies to better understand the capacity of avian viruses to infect, cause disease, and transmit among mammals, including humans. Seroepidemiologic studies that evaluate the frequency and risk of human infection with avian influenza viruses in populations with exposure to domestic or wild birds can provide a better understanding of the pandemic potential of avian influenza subtypes. Investigations conducted in Hong Kong following the first H5N1 outbreak in humans in 1997 determined that exposure to poultry in live bird markets was a key risk factor for human disease. Among poultry workers, butchering and exposure to sick poultry were risk factors for antibody to H5 virus, which provided evidence for infection. A second risk assessment tool, the ferret, can be used to evaluate the level of virulence and potential for host-to-host transmission of avian influenza viruses in this naturally susceptible host. Avian viruses isolated from humans exhibit a level of virulence and transmissibility in ferrets that generally reflects that seen in humans. The ferret model thus provides a means to monitor emerging avian influenza viruses for pandemic risk, as well as to evaluate laboratory-generated reassortants and mutants to better understand the molecular basis of influenza virus transmissibility. Taken together, such studies provide valuable information with which we can assess the public health risk of avian influenza viruses.

Chiral paramagnetic skyrmion-like phase in MnSi

We present a comprehensive study of chiral fluctuations in the reference helimagnet MnSi by polarized neutron scattering and neutron spin echo spectroscopy, which reveals the existence of a completely left-handed and dynamically disordered phase. This phase may be identified as a spontaneous Skyrmion phase: it appears in a limited temperature range just above the helical transition T_{C} and coexists with the helical phase at T_{C}.

Generalized spin-glass relaxation

Spin relaxation close to the glass temperature of CuMn and AuFe spin glasses is shown, by neutron spin echo, to follow a generalized exponential function which explicitly introduces hierarchically constrained dynamics and macroscopic interactions. The interaction parameter is directly related to the normalized Tsallis nonextensive entropy parameter q and exhibits universal scaling with reduced temperature. At the glass temperature q=5/3 corresponding, within Tsallis' q statistics, to a mathematically defined critical value for the onset of strong disorder and nonlinear dynamics.

An investigation of flat panel equipment variables on image quality with a dedicated cardiac phantom

Image quality (IQ) evaluation plays a key role in the process of optimization of new x-ray systems. Ideally, this process should be supported by real clinical images, but ethical issues and differences in anatomy and pathology of patients make it impossible. Phantom studies might overcome these issues. This paper presents the IQ evaluation of 30 cineangiographic films acquired with a cardiac flat panel system. The phantom used simulates the anatomy of the heart and allows the circulation of contrast agent boluses through coronary arteries. Variables investigated with influence on IQ and radiation dose are: tube potential, detector dose, added Copper filters, dynamic density optimization (DDO) and viewing angle. The IQ evaluation consisted of scoring 4 simulated calcified lesions located on different coronary artery segments in terms of degree of visualization. Eight cardiologists rated the lesions using a five-point scale ((1) lesion not visible to (5) very good visibility). Radiation doses associated to the angiograms are expressed in terms of incident air kerma (IAK) and effective dose that has been calculated with PCXMX software (STUK, Finland) from the exposure settings assuming a standard sized patient of 70 Kg. Mean IQ scores ranged from 1.68 to 4.88. The highest IQ scores were obtained for the angiograms acquired with tube potential 80 kVp, no added Cu filters, DDO 60%, RAO and LAO views and the highest entrance detector dose that has been used in the present study, namely 0.17 microGy/im. Radiation doses (IAK approximately 40 mGy and effective dose of 1 mSv) were estimated for angiograms acquired at 15 frames s(-1), detector field-of-view 20 cm, and a length of 5 s. The following parameters improved the IQ factor significantly: a change in tube potential from 96 to 80 kVp, detector dose from 0.10 microGy/im to 0.17 microGy/im, the absence of Copper filtration. DDO variable which is a post-processing parameter should be carefully evaluated because it alters the quality of the images independently of radiation exposure settings. The SAM anthropomorphic phantom has the advantage of visualization of stenotic lesions during the injection of a contrast agent and using an anatomical background. In the future, this phantom could potentially bridge the gap between physics tests and the clinical reality in the catheterization laboratory.

An e-learning platform for aerospace medicine

The appeal of online education and distance learning as an educational alternative is ever increasing. To support and accommodate the over-specialized knowledge available by different experts, information technology can be employed to develop virtual distributed pools of autonomous specialized educational modules and provide the mechanisms for retrieving and sharing them. New educational standards such as SCORM and Healthcare LOM enhance this process of sharing by offering qualities like interoperability, accessibility, and reusability, so that learning material remains credible, up-to-date and tracks changes and developments of medical techniques and standards through time. Given that only a few e-learning courses exist in aerospace medicine the material of which may be exchanged among teachers, the aim of this paper is to illustrate the procedure of creating a SCORM compliant course that incorporates notions of recent advances in social web technologies. The course is in accordance with main educational and technological details and is specific to pulmonary disorders in aerospace medicine. As new educational trends place much emphasis in continuing medical education, the expansion of a general practitioner's knowledge in topics such as aviation and aerospace pulmonary disorders for crew and passengers becomes a societal requirement.

Effect of 1- and 10-day administration of tepoxalin on minimum alveolar concentration of isoflurane and sevoflurane in dogs

Analgesics given preoperatively have the potential to decrease the amount of inhalant anesthetics required intraoperatively (i.e., to decrease the minimum alveolar concentration, or MAC, for the inhalant). Tepoxalin is an NSAID approved for the treatment of arthritis in dogs in the United States and, hence, could be administered to patients undergoing anesthesia. In this study, administration of a single dose or a 10-day course of tepoxalin did not affect the MAC for isoflurane or sevoflurane.

Andreas Rett and benign familial neonatal convulsions revisited

In 1964 Andreas Rett published the first account of a family with benign familial neonatal convulsions (BFNC). The authors retraced Rett's family and report that the clinical and genetic features of this original family fit the currently accepted definitions of BFNC. They also consider the career of Dr. Rett, a researcher and social reformer as well as an advocate for the rights of children with developmental disabilities.

Human T-lymphotropic virus type I/II infections in volunteer blood donors from Northern and Western Greece: increased prevalence in one blood bank unit

BACKGROUND: Blood donors are routinely screened for antibodies to human T-cell lymphotropic viruses type I and II (HTLV-I and HTLV-II) in the United States, Canada, Japan, and some European countries. Previous reports from our group in relatively small numbers of donors have shown a zero prevalence of HTLV-I/II markers in our region. In this study, seven blood banks in the north and west of Greece participated in order to determine whether mandatory screening of blood donations for HTLV-I/II infection should be established. METHODS: Sera from 51,714 consecutive donors were investigated for anti-HTLV-I/II using two commercially available enzyme immunoassays (EIAs). Reactive samples in one or both EIAs were repeatedly evaluated further by Western blot, which is specific for both confirmation and differentiation of HTLV-I and HTLV-II seroreactivities. Investigation for HTLV DNA was also done in all EIA-reactive donors, irrespective of the WB result, using a combination assay based on the polymerase chain reaction (PCR) and a DNA EIA. RESULTS: A total of 115 donors (0.222%; 95% CI 0.018-0.26%) were initially considered reactive for anti-HTLV-I/II by EIAs. However, only 7 of the 115 were confirmed as positive by WB (five HTLV-I and two HTLV-I/II). Thus, the prevalence of anti-HTLV-I/II in donors from northern and western Greece was 0.013% (95% CI 0.003-0.023%). Interestingly, the majority of WB-confirmed anti-HTLV-positive individuals were detected in the blood bank of Corfu (5/7, all anti-HTLV-I). This prevalence (5/15383; 0.032%; 95% CI 0.004-0.061%) was six times the prevalence found at the other blood banks combined (2/36331; 0.0055%; 95% CI 0-0.013%), but it was not statistically significant. None of the EIA-reactive donors had detectable HTLV DNA. CONCLUSIONS: The very low prevalence of confirmed anti-HTLV-I/II infection markers in northern and western Greek blood donors, together with the negative PCR results in EIA-reactive subjects, indicates that anti-HTLV-I/I routine screening is not really justified in this area of our country. However, the increased prevalence of WB-confirmed anti-HTLV-I-positive donors in the Corfu blood bank calls for further prospective and careful investigation in order to address whether this finding represents a real cluster phenomenon of HTLV infection.

Estimation of Distance Between a Unipolar Recording Electrode and a Myocardial Bundle Based on Signal Characteristics

The aim of the present paper, is the estimation of the distance between an electrode used as a recording site of the extracellular potential field and a surviving myocardial bundle. The importance of the reliable solution of this problem lies among others in controlling ablation. For our purposes one-dimensional propagation is considered and current sources are activated along a cable simulating the propagating waves with constant velocity. Different models of current sources are explored. By use of these models, the corresponding functions expressing extracellular potentials are calculated, using the volume conductor equation. This way, extracellular potentials are modeled as parametric functions of longitudinal distance, while perpendicular distance, current source strength, and other factors related to the propagated wave are parameters of the functions. Simulated annealing is applied for model parameter estimation and appropriate Time Domain and Wavelet Domain cost functions are investigated. Different combinations of model and cost function are evaluated regarding the accuracy of distance estimation. A continuous source model function with a wavelet cost function was found to be the most accurate combination. The accuracy of distance estimation is related to the selected source model and to the actual distance of recording in a nonmonotonic way.